Provider Demographics
NPI:1083595623
Name:BEARDALL, KYRA NOELLE (BS, SLPA)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:NOELLE
Last Name:BEARDALL
Suffix:
Gender:F
Credentials:BS, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-7456
Mailing Address - Country:US
Mailing Address - Phone:480-982-1110
Mailing Address - Fax:
Practice Address - Street 1:1755 N IDAHO RD
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-1716
Practice Address - Country:US
Practice Address - Phone:480-677-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA149222355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant